As of October 2016, the Philippines remains to be one of 18 countries where maternal and neonatal tetanus remains to be a major public health problem, reports the World Health Organization (WHO).

People of all ages can get tetanus, and it is considered a medical emergency. But the bacterial disease is often fatal to fetuses and newborns. A pregnant woman who contracts the disease can transfer the infection to her unborn baby, causing fetal death.

“Women face an additional risk of infection if a contaminated tool is used during childbirth or during an abortion,” says WHO. They can get infected through unhygienic birthing practices, such as when the instrument used to cut the umbilical cord, like a knife or razor, is unsterile. Culprits also include dirty dressings and unclean hands of the person delivering the baby.

According to the Department of Health (DOH), tetanus is not transmitted from person-to-person but is acquired when the spores of the bacterium Clostridium, often found in dirt and soil, enters the body through open wounds and cuts.

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A tetanus infection spreads fast, and an infected newborn can die within a few days. “Between 70 and 100 percent of deaths occur between three days and 28 days after birth,” says UNICEF. In the Philippines, a majority of the neonatal tetanus cases (77 percent) are from the 3 to 7 day-old age group, according to a 2016 report from the DOH. “It is particularly common in rural areas where deliveries are done at home without adequate sterile procedures,” says the report.

According to WHO, tell-tale signs of tetanus in infants include tightening of the jaw and facial muscles, which can worsen until the baby is no longer able to feed. The infection then spreads throughout the whole body, causing stiffening, convulsions, muscle spasms and sensitivity to light, sound, and touch. He will also find it difficult to breathe.

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The best protection against it is vaccination and good childcare practice. As recommended by the Philippine Foundation for Vaccination (PFV), the tetanus vaccine is usually given to pregnant women in a three-in-one shot in properly spaced-out doses (it includes immunization for diphtheria and pertussis or a whooping cough, which are also potentially life-threatening diseases).

The vaccine is included in PhilHealth’s maternity care package, which was updated and expanded in February 2016. A portion of the P8,000 coverage amount is allotted for prenatal care services, which can be used for immunizations, medicines, lab tests and doctor’s professional fees. “Pinahahalagahan natin ang kalusugan ng lahat ng Filipino, lalo na ang mga magiging ina at kanilang sanggol,” says former PhilHealth president and CEO Alexander A. Padilla.

To see the full list of vaccines recommended for adults by the PFV, including expectant mothers, click here.